Successfully Managing Chronic Health Conditions with Human

Cognizant 20-20 Insights Digital Business Successfully Managing Chronic Health Conditions with Human- Centered Digital Therapeutics By adopting evidence-based digital therapeutics, healthcare organizations can alleviate the mounting costs of caring for the growing number of patients with chronic conditions — and enter the fourth wave of digital healthcare. Executive Summary Caring for individuals who suffer from chronic health While the U.S. healthcare system generally excels when conditions, such as diabetes, high blood pressure, delivering emergency and acute care, it falters when congestive heart failure (CHF) and chronic obstructive treating incurable conditions that must be managed and pulmonary disease (COPD), costs the U.S. healthcare controlled. Payers, providers and industry regulators are system billions of dollars annually. Much of this expense all too familiar with the results of ineffective management is due to ineffective management of these conditions — of chronic conditions: expensive emergency department not only by patients themselves but also by the (ED) visits, hospital admissions and, often, return ED visits healthcare system. and readmissions. Yet despite the costs and care, most February 2019 Cognizant 20-20 Insights patients experience minimal progress in managing behavior and adhere to prescribed therapies. In our their underlying conditions. follow-up ethnographic study, we set the goal of identifying the digital capabilities that healthcare Why does the healthcare system struggle to organizations can adopt to provide patients with effectively manage these conditions? In large part, warm care so that together, they can better manage it’s because people must change their behaviors: chronic conditions. taking medications, eating more healthfully, exercising regularly, practicing self-care — actions In this new ethnographic study, we immersed that even the healthiest of people find challenging. ourselves in the lives of patients and interviewed Rather than giving orders and expecting linear physicians at some of the largest U.S. healthcare results, health systems, physicians and caregivers systems. The study offered clear insights into the must instead support patients throughout their capabilities that patients and physicians want when journeys as they experiment with how best it comes to managing chronic conditions. Armed to manage their conditions. And payers and with these findings, we developed a prototype regulators must adopt a new and very different of a conversational AI-based digital therapeutic reimbursement model that rewards providers solution designed to assist patients with CHF. based on their ability to successfully manage This report outlines what we learned about the chronic conditions. willingness of patients and physicians to use digital Digital tools, especially rigorous digital therapeutics, therapies to manage chronic conditions such as can help the industry achieve these goals. Our CHF, and what the industry must do to incorporate landmark study “Helping People Heal” revealed digital therapeutics into its ecosystem, from the that when patients get “warm,” supportive care, care continuum to reimbursement and regulation. they’re more likely to successfully change their 2 / Successfully Managing Chronic Health Conditions with Human-Centered Digital Therapeutics Cognizant 20-20 Insights Understanding the chronically ill patient More than 100 million people in the U.S. suffer from Our discussions included the following questions: one or more chronic healthcare conditions.1 These ❙ What are the biggest barriers you’ve faced in often-incurable conditions must be managed your daily activities since your diagnosis? carefully for patients to avoid disease progression and maintain a good quality of life. But despite the ❙ What were the major pain points during your U.S. healthcare system spending approximately hospitalization or recent doctor’s visit? 2 $3 trillion on chronic conditions annually, chronic ❙ What do you think of digital advances conditions persist. And despite the industry’s focus in medicine? on patient engagement, efforts to reduce the ❙ How ready are you to manage your medical progression and complications of chronic illness, condition yourself? especially those that are lifestyle-influenced, seem largely ineffectual. ❙ What does the ideal solution look like? ❙ How would you like technology to support Our initial study on healing revealed that patients your care? require empathic support to help manage the physical and emotional aspects of healing, and After weeks of study, we developed a patient yet the healthcare system rarely addresses these persona, Marge. Marge is a 68-year-old woman needs. Instead, the system tends to be cold and who lives by herself and is active within her linear, and focused on strict adherence. Most community. She has a history of diabetes and technological solutions mirror these tendencies; hypertension and is on several medications. that is, healthcare organizations use technology to Complications from the diabetes and hypertension streamline existing processes rather than reimagine lead to an emergency department visit, hospital processes from the patient perspective. admission and diagnosis of CHF (see QuickTake, page 5). Despite good care at the hospital and This approach has not netted the hoped-for detailed discharge instructions, within the month, outcomes in managing chronic illnesses. We set out Marge is readmitted to the hospital. Marge’s to learn more about the qualities that would make journey highlights the core patient issues that must a digital disease management tool effective for be immediately addressed through a reimagined patients and physicians. care model: To gain deep perspective, we started with an ❙ Lack of clear down-to-earth information ethnographic study of patients diagnosed with about the patient’s condition. Patients rarely CHF and their providers. Selected patients understand the mechanics of their conditions, spanned various socioeconomic groups. Our how several chronic conditions and treatments researchers shadowed these individuals and talked might interact, and what their prescriptions are with them at length to understand their journeys focused on accomplishing. and the friction points they experience. 3 / Successfully Managing Chronic Health Conditions with Human-Centered Digital Therapeutics Cognizant 20-20 Insights ❙ Weak support system. Because of stringent or calls might come when the patient feels fine. privacy regulations surrounding personal health It’s in the moments when the patient “doesn’t data, providers can’t easily connect patients with feel right” — which the provider can’t predict — other individuals managing similar conditions when they most need contact. who could provide practical advice and support. ❙ Limited support for changing behaviors. ❙ Complicated prescription schedule. Adopting new long-term behaviors, such as Individuals with CHF are commonly prescribed eating healthier foods, exercising regularly or up to seven medications and take more than overcoming an addiction, is a challenge for even 10 doses a day,3 which makes it easy to forget the healthiest people. Regular encouragement a dosage. When taking several medications at for weeks or months is required to make new a time, it might be hard to pinpoint which one behaviors stick.4 caused an uncomfortable side effect, resulting ❙ Inability to effectively self-monitor condition. in patients choosing to skip dosages altogether, It’s difficult for an individual to distinguish especially if no one has clearly explained what between minor symptoms and more serious the pills do. ones. Given the difficulty with reaching a primary ❙ Lack of adequate post-discharge provider care physician quickly, frightened patients tend communication. Patients can easily miss post- to go to emergency departments. discharge phone calls from a healthcare system, Patients described the capabilities they’d like to see for solving the problems above: ❙ A simple-to-use, single solution that addresses all their conditions and gives them bite-sized instructions to adhere to their complicated daily treatment routines. ❙ Clear information about their disease and explanations about what their medications should accomplish. ❙ The ability to blend medical adherence and other changes into their existing lifestyles to avoid the disease or illness becoming the focus of their lives. ❙ The ability to quickly reach a provider when necessary. ❙ Timely guidance, reassurance and feedback from providers about how well they’re managing their conditions. 4 / Successfully Managing Chronic Health Conditions with Human-Centered Digital Therapeutics Cognizant 20-20 Insights Quick Take Marge: the journey of the chronically ill patient We conducted an in-depth study of chronically ill patients to understand the factors preventing them from managing their conditions more effectively. Most chronically ill patients suffer from more than one chronic condition, and conditions can exacerbate one another. A person diagnosed with CHF likely has additional diagnoses of hypertension and diabetes and, on average, takes seven prescription medications. As we talked with and followed patients in their daily routines, a clear persona of the chronically ill patient emerged. She is Marge, a 68-year-old woman who lives alone. Her journey is all too typical in the U.S. healthcare system. Marge’s journey Discharge Medications prescribed, and Inability to ﬁll some treatment information provided prescriptions

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